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*For medical professionals only
Alcoholic toxic encephalopathy includes acute and chronic alcoholic toxic encephalopathy
.
Chronic alcoholic toxic encephalopathy refers to a chronic, easily recurrent brain disease caused by alcohol acting on brain tissue caused by long-term drinking, which is a serious poisoning of the central nervous system caused by long-term excessive drinking, which can be life-threatening
.
The author summarizes the types of chronic alcoholic toxic encephalopathy so that peers can quickly locate and qualitatively
in clinical diagnosis.
According to the clinical manifestations of patients, the onset of the disease, the duration of the disease, etc.
, chronic alcoholic toxic encephalopathy is divided into six types
: Wernicke encephalopathy, Korsakov syndrome, chronic alcoholic toxic dementia, alcoholic tremor-delirium, alcoholic epilepsy, alcoholic mental and behavioral disorders.
▌Wernicke encephalopathy typical of Wernicke encephalopathy
patients can have three sets of characteristic symptoms: ophthalmoplegia, psychiatric abnormalities and ataxia.
More acute or subacute onset, vomiting and nystagmus are the earliest symptoms, ophthalmoplegia is one of
the characteristic manifestations of the disease.
Ataxia often follows ocular symptoms
.
Most patients have severe symptoms at first and progress to difficulty standing and walking within a few days; Mild patients have cerebellar ataxia, with a wide step base when walking, which is easy to fall; Individual patients may also be accompanied by slurred speech and incoherent arthria
.
More than 80% of patients have psychiatric symptoms, but sometimes the manifestations are insidious and require careful examination
by a physician.
▌ Korsakov syndrome is also known as alcohol amnesia syndrome
.
Typical clinical manifestations include amnesia, fiction, misarthronism, cognitive dysfunction, disorientation, and personality changes
.
These clinical manifestations are often based on cognitive dysfunction, decreased learning ability, and personality changes
.
Patients often fail to retain new information and show forgetting, but in order to fill the gap in this regard, the patient describes events that have occurred in the past time as having occurred at this time, or fills in the forgotten passage with a ridiculous, changeable, rich and diverse fictional fact, and firmly believes in it
.
In addition, patients often show indifference in personality, lack of initiative, lack of initiative and concern for the surrounding personnel, but sometimes appear selfish and stubborn, euphoric and superficial, or emotional fluctuations are very intense
.
▌ Chronic alcohol-toxic dementia
is a significant cognitive dysfunction caused by chronic alcoholism, which can develop from Wernicke's encephalopathy or Korsakov syndrome, a significant decline in personal life ability, slovenliness, poor personal hygiene, and the need for alcohol more than anything
.
In patients with long-term heavy drinking, some patients develop organic dementia of the brain, alcohol-dependent patients have repeated tremors, delirium, spasm seizures, acute or chronic progressive personality changes, mental retardation, memory impairment dementia state
.
Delirium caused by Korsakov syndrome and alcoholic tremor is rare, the course of the disease is mostly slow to develop, the initial stage may be burnout, the late stage speech function is also seriously impaired, can only only speak, and finally bedridden, urinary incontinence, more due to various complications and death
.
▌Alcoholic tremor - delirium
The disease can be triggered by some factors that weaken the body's resistance, such as trauma and infection
.
The classic prodrome is insomnia, fear, and tremor, and the classic triad is delirium with vivid hallucinations or delusions, behavioral disturbances, and overt tremor
.
Tremor is mostly gross tremor, especially in fingers, face, tongue and other parts, sometimes lack of regularity, manifested as rocking tremor
.
Delirium appears within a few days, the patient loses orientation, accompanied by a variety of vivid hallucinations, mainly visual hallucinations, often accompanied by misrepresentation and fiction
.
It may be accompanied by delusions of victimization, and even suicidal or self-injury or aggression, impulsive manifestations
.
The disease usually lasts for several days, and patients usually have no memories
of the experience.
The case fatality rate is lower in patients without complications with prompt management, but significantly higher
when complications (eg, pneumonia, heart failure) occur.
▌The clinical manifestations of alcoholic epilepsy are a variety of types of seizures, with generalized tonic-clonic seizures being more common, and status epilepticus
can be present in severe cases
.
▌Alcoholic psychiatric and behavioral disorders include withdrawal from long-term alcohol use disorder and accompanying personality, mood disorder, or psychotic disorders
.
Mood disorders are often manifested as depression, anxiety and other manifestations, patients have mixed emotions, changeable, poor stability, long duration, poor response to drugs, and accompanied by personality abnormalities, hallucinations, sleep disorders, or cognitive dysfunction
.
of chronic alcoholic toxic encephalopathy should begin with a history of long-term alcohol consumption or alcohol
dependence.
The core symptoms/diagnostic criteria for alcohol dependence are described as follows (3 or more of the following within 12 months):
Since the clinical manifestations and severity of patients may also be closely related to factors such as the type of alcohol, the time of initiation, the amount and frequency of drinking, whether the alcohol is accompanied by food, and the functional status of the nervous system, clinicians should make a comprehensive judgment
based on the above diagnostic criteria, combined with clinical manifestations and imaging features.
of chronic alcohol-toxic encephalopathy■ The first treatment for chronic
alcohol-toxic encephalopathy is abstinence.
Treatment is generally divided into 2 stages: one is the abstinence stage, also known as the detoxification stage; The other stage is the rehabilitation phase
.
Aggressive drug therapy can help patients wean themselves off alcohol dependence and prevent recurrence
.
Alcohol withdrawal in patients with severe alcoholism should be hospitalized to prevent serious complications
.
■ The current first-line treatment drugs are: (1) nalmefine, naloxone, naltrexone; (2) disulfiram; (3) Acampric acid
.
Second-line treatment drugs are: (1) baclofen; (2) topiramate; (3) benzodiazepines; (4) tricyclic antidepressants; (5) Large doses of antioxidants
.
■ Causes Treatment
of chronic alcoholic toxic encephalopathy The cause is ammonium sulfate (vitaminB1) deficiency caused by gastrointestinal malabsorption, Therefore, the key to treatment is to treat
the cause and pathogenesis.
If chronic alcohol-toxic brain injury is not treated in time, its natural history can continue to develop, eventually leading to coma, shock, cardiovascular and neurological failure
.
■ Correction of nutritional disorders
is an important factor that causes and aggravates chronic alcoholic toxic encephalopathy, and such patients are often accompanied by malnutrition, so correcting nutritional disorders is the basis for
alleviating the disease and early recovery.
Intravenous water, electrolytes, vitamin B1, and vitamin C should be given
.
Patients are deficient in vitamin A, B complex vitamins and C, carnitine, magnesium, selenium, zinc, and essential fatty acids and antioxidants, and supplementation of nutrients, especially B vitamins, can help recovery
.
■ Cerebroprotective therapy Patients with long-term alcoholism have peroxide and free radical damage and obvious low levels of neurotrophic factors in the brain, so appropriate and effective neuroprotective therapy
can help improve the symptoms
of chronic alcohol-toxic encephalopathy.
In addition to the use of high-dose vitamin C and supplementation of B vitamins such as methylcobalamin, free radical scavengers such as edaravone, mitochondrial protectors such as idebenone, coenzyme Q10, etc.
, and neurotrophic drugs such as murine nerve growth factor, oxiracetam, etc
.
can also be given.
■ Treatment of various types of syndromes
The main problem affecting the recovery of alcoholics is re-drinking
.
Preventing alcohol consumption can be difficult, requiring sustained treatment, motivation and strong social support to consolidate the results
achieved.
Other ways to prevent re-drinking include changing daily habits and avoiding contact or activities
with people who are drinking.
90% of alcoholics smoke, and those who quit are more likely to achieve long-term abstinence and other health benefits
.
In addition
, psychological counseling and psychotherapy should be added.
Questionnaire survey
Literature:Zhi,2022,30(3):207-218
6 categories are complete!
Alcoholic toxic encephalopathy includes acute and chronic alcoholic toxic encephalopathy
.
Chronic alcoholic toxic encephalopathy refers to a chronic, easily recurrent brain disease caused by alcohol acting on brain tissue caused by long-term drinking, which is a serious poisoning of the central nervous system caused by long-term excessive drinking, which can be life-threatening
.
The author summarizes the types of chronic alcoholic toxic encephalopathy so that peers can quickly locate and qualitatively
in clinical diagnosis.
1
According to the clinical manifestations of patients, the onset of the disease, the duration of the disease, etc.
, chronic alcoholic toxic encephalopathy is divided into six types
: Wernicke encephalopathy, Korsakov syndrome, chronic alcoholic toxic dementia, alcoholic tremor-delirium, alcoholic epilepsy, alcoholic mental and behavioral disorders.
▌Wernicke encephalopathy typical of Wernicke encephalopathy
patients can have three sets of characteristic symptoms: ophthalmoplegia, psychiatric abnormalities and ataxia.
More acute or subacute onset, vomiting and nystagmus are the earliest symptoms, ophthalmoplegia is one of
the characteristic manifestations of the disease.
Ataxia often follows ocular symptoms
.
Most patients have severe symptoms at first and progress to difficulty standing and walking within a few days; Mild patients have cerebellar ataxia, with a wide step base when walking, which is easy to fall; Individual patients may also be accompanied by slurred speech and incoherent arthria
.
More than 80% of patients have psychiatric symptoms, but sometimes the manifestations are insidious and require careful examination
by a physician.
▌ Korsakov syndrome is also known as alcohol amnesia syndrome
.
Typical clinical manifestations include amnesia, fiction, misarthronism, cognitive dysfunction, disorientation, and personality changes
.
These clinical manifestations are often based on cognitive dysfunction, decreased learning ability, and personality changes
.
Patients often fail to retain new information and show forgetting, but in order to fill the gap in this regard, the patient describes events that have occurred in the past time as having occurred at this time, or fills in the forgotten passage with a ridiculous, changeable, rich and diverse fictional fact, and firmly believes in it
.
In addition, patients often show indifference in personality, lack of initiative, lack of initiative and concern for the surrounding personnel, but sometimes appear selfish and stubborn, euphoric and superficial, or emotional fluctuations are very intense
.
▌ Chronic alcohol-toxic dementia
is a significant cognitive dysfunction caused by chronic alcoholism, which can develop from Wernicke's encephalopathy or Korsakov syndrome, a significant decline in personal life ability, slovenliness, poor personal hygiene, and the need for alcohol more than anything
.
In patients with long-term heavy drinking, some patients develop organic dementia of the brain, alcohol-dependent patients have repeated tremors, delirium, spasm seizures, acute or chronic progressive personality changes, mental retardation, memory impairment dementia state
.
Delirium caused by Korsakov syndrome and alcoholic tremor is rare, the course of the disease is mostly slow to develop, the initial stage may be burnout, the late stage speech function is also seriously impaired, can only only speak, and finally bedridden, urinary incontinence, more due to various complications and death
.
▌Alcoholic tremor - delirium
The disease can be triggered by some factors that weaken the body's resistance, such as trauma and infection
.
The classic prodrome is insomnia, fear, and tremor, and the classic triad is delirium with vivid hallucinations or delusions, behavioral disturbances, and overt tremor
.
Tremor is mostly gross tremor, especially in fingers, face, tongue and other parts, sometimes lack of regularity, manifested as rocking tremor
.
Delirium appears within a few days, the patient loses orientation, accompanied by a variety of vivid hallucinations, mainly visual hallucinations, often accompanied by misrepresentation and fiction
.
It may be accompanied by delusions of victimization, and even suicidal or self-injury or aggression, impulsive manifestations
.
The disease usually lasts for several days, and patients usually have no memories
of the experience.
The case fatality rate is lower in patients without complications with prompt management, but significantly higher
when complications (eg, pneumonia, heart failure) occur.
▌The clinical manifestations of alcoholic epilepsy are a variety of types of seizures, with generalized tonic-clonic seizures being more common, and status epilepticus
can be present in severe cases
.
▌Alcoholic psychiatric and behavioral disorders include withdrawal from long-term alcohol use disorder and accompanying personality, mood disorder, or psychotic disorders
.
Mood disorders are often manifested as depression, anxiety and other manifestations, patients have mixed emotions, changeable, poor stability, long duration, poor response to drugs, and accompanied by personality abnormalities, hallucinations, sleep disorders, or cognitive dysfunction
.
2
The clinical diagnosisof chronic alcoholic toxic encephalopathy should begin with a history of long-term alcohol consumption or alcohol
dependence.
The core symptoms/diagnostic criteria for alcohol dependence are described as follows (3 or more of the following within 12 months):
(1) tolerance to alcohol (need to consume more to achieve pleasure);
(2) withdrawal symptoms/reactions after stopping drinking;
(3) excessive intake;
(4) Uncontrollable and abstaining;
(5) Spending a lot of time seeking, obtaining, and ingesting alcohol;
(6) Decreased willingness to engage in social interactions;
(7) Regardless of any adverse consequences (physical/psychological problems).
Since the clinical manifestations and severity of patients may also be closely related to factors such as the type of alcohol, the time of initiation, the amount and frequency of drinking, whether the alcohol is accompanied by food, and the functional status of the nervous system, clinicians should make a comprehensive judgment
based on the above diagnostic criteria, combined with clinical manifestations and imaging features.
3
Treatmentof chronic alcohol-toxic encephalopathy■ The first treatment for chronic
alcohol-toxic encephalopathy is abstinence.
Treatment is generally divided into 2 stages: one is the abstinence stage, also known as the detoxification stage; The other stage is the rehabilitation phase
.
Aggressive drug therapy can help patients wean themselves off alcohol dependence and prevent recurrence
.
Alcohol withdrawal in patients with severe alcoholism should be hospitalized to prevent serious complications
.
■ The current first-line treatment drugs are: (1) nalmefine, naloxone, naltrexone; (2) disulfiram; (3) Acampric acid
.
Second-line treatment drugs are: (1) baclofen; (2) topiramate; (3) benzodiazepines; (4) tricyclic antidepressants; (5) Large doses of antioxidants
.
■ Causes Treatment
of chronic alcoholic toxic encephalopathy The cause is ammonium sulfate (vitaminB1) deficiency caused by gastrointestinal malabsorption, Therefore, the key to treatment is to treat
the cause and pathogenesis.
If chronic alcohol-toxic brain injury is not treated in time, its natural history can continue to develop, eventually leading to coma, shock, cardiovascular and neurological failure
.
■ Correction of nutritional disorders
is an important factor that causes and aggravates chronic alcoholic toxic encephalopathy, and such patients are often accompanied by malnutrition, so correcting nutritional disorders is the basis for
alleviating the disease and early recovery.
Intravenous water, electrolytes, vitamin B1, and vitamin C should be given
.
Patients are deficient in vitamin A, B complex vitamins and C, carnitine, magnesium, selenium, zinc, and essential fatty acids and antioxidants, and supplementation of nutrients, especially B vitamins, can help recovery
.
■ Cerebroprotective therapy Patients with long-term alcoholism have peroxide and free radical damage and obvious low levels of neurotrophic factors in the brain, so appropriate and effective neuroprotective therapy
can help improve the symptoms
of chronic alcohol-toxic encephalopathy.
In addition to the use of high-dose vitamin C and supplementation of B vitamins such as methylcobalamin, free radical scavengers such as edaravone, mitochondrial protectors such as idebenone, coenzyme Q10, etc.
, and neurotrophic drugs such as murine nerve growth factor, oxiracetam, etc
.
can also be given.
■ Treatment of various types of syndromes
1.
Wernicke encephalopathy and Korsakoff syndrome: The pathogenesis of Wernicke encephalopathy and Korsakoff syndrome is mainly ammonium sulfide deficiency, so B vitamins can be actively supplemented through non-enteral supplementation, including intramuscular injection of vitamin B 1 injection and intramuscular or intravenous injection of methylcobalamin injection (1000μg, 1 time / d).
2.
Chronic alcohol toxic dementia: impaired cholinergic function of the brain is the main mechanism of chronic alcohol toxic dementia, alcohol inhibits acetylcholine activity, resulting in loss of hippocampal and frontal cholinergic neurons, causing cognitive decline
.
Clinical use of cholinesterase inhibitor donepezil and NMDA receptor non-competitive antagonist memantine, the recommended dose is: donepezil 5-10mg orally, once / d, 4-6 weeks later to increase to 10mg oral, once / d; For the first 3 weeks of memantine treatment, the dose is increased by 5 mg/d to 10 mg orally twice a day
.
3.
Alcoholic tremor-delirium: short-term application of benzodiazepines is preferred, and antipsychotics such as haloperidol or olanzapine
are used if necessary.
4.
Alcoholic epilepsy: seizures during withdrawal or convalescent should be actively treated with antiepileptic drugs, benzodiazepines are preferred, such as lorazepam or diazepam, if necessary, sodium valproate extended-release tablets or levetiracetam can be combined to adjust to the lowest safe and effective dose, and the drug should be considered after 1-2 years of abstinence from alcohol and complete control of seizures, and appropriately prolonged
according to the patient's brain injury.
5.
Alcoholic mental and behavioral disorders: Alcohol can have a significant impact on the central neurotransmitter system, including central neurotransmitters
such as dopamine, γ-aminobutyric acid, and serotonin.
Therefore, patients with anxiety and depression disorders should be treated aggressively, including the use of selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, or serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine or duloxetine, or thiatonic neuroleptic drugs such as haloperethan melitrexine tablets, It can also be used in combination with proprietary Chinese medicines such as Liver Relief Capsules, Wuling Capsules, etc
.
For mild anxiety and depressive disorders, the above proprietary Chinese medicines alone also have certain effects, and there are fewer
side effects.
The main problem affecting the recovery of alcoholics is re-drinking
.
Preventing alcohol consumption can be difficult, requiring sustained treatment, motivation and strong social support to consolidate the results
achieved.
Other ways to prevent re-drinking include changing daily habits and avoiding contact or activities
with people who are drinking.
90% of alcoholics smoke, and those who quit are more likely to achieve long-term abstinence and other health benefits
.
In addition
, psychological counseling and psychotherapy should be added.
Questionnaire survey
Stroke (commonly known as "stroke") has the characteristics of "four highs" with high morbidity, high disability rate, high mortality rate and high recurrence rate, acute onset, rapid progression and serious consequences, 1 in every 4 people in the world will have a stroke, 1 person will die of stroke every 6 seconds, and 1 person will be disabled due to stroke every 6 seconds, and the patient's family will suffer huge economic losses and physical and mental suffering
.
Literature:Zhi,2022,30(3):207-218
References:
[1] Cheng Yali, Yang Jun, Cao Du, et al.
Research progress in the diagnosis and treatment of chronic alcohol toxic encephalopathy[J].
China Pharmaceutical Industry,2020.
29(19).
[2] LI Yi, PENG Ying.
Interpretation of "Chinese expert consensus on the diagnosis and treatment of chronic alcohol toxic encephalopathy"[J].
Chinese Journal of Modern Neurological Diseases,2019.
19(01).
[3] LI Yi.
Chinese expert consensus on the diagnosis and treatment of chronic alcohol toxic encephalopathy[J].
Chinese Journal of Neurology,2018.
17(01).
